Shaping the Future: Challenges and Opportunities

Pamela S. Hyde, J.D.SAMHSA Administrator

NIATx Summit / SAAS Conference Federal Leadership Panel

Boston, MA • July 12, 2011

FOCUS AREAS FOR TODAY’S DISCUSSION

CONTEXT OF CURRENT CHANGE

RECOVERY

DISPARITIES

NATIONAL BEHAVIORAL HEALTH QUALITY FRAMEWORK

COMMUNICATIONS & MESSAGE

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CONTEXT OF CHANGE – 1

Budget constraints• Unprecedented economic challenges

Science and understanding has evolved• Not yet a common language • No system in place to move to scale innovative

practices and systems change that promotes recovery• Behavioral health still seen as moral failure or social

problem

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CONTEXT OF CHANGE – 2

Integrated care requires new thinking• About recovery, wellness, role of peers• Responding to whole health needs; not just one

disease

Evolving role and new opportunities for behavioral health in health care• Parity/Health Reform• Tribal Law and Order Act• National Action Alliance for Suicide Prevention

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Health Reform

State Budget Declines

Federal

Domestic

Spending

EMERGING SCIENCE

DRIVERS OF CHANGE 6

STAYING FOCUSED DURING CHANGE7

SAMHSA’S STRATEGIC INITIATIVES

AIM: Improving the Nation’s Behavioral Health (1-4)AIM: Transforming Health Care in America (5-6)AIM: Achieving Excellence in Operations (7-8)

1. Prevention

2. Trauma and Justice

3. Military Families

4. Recovery Support

5. Health Reform

6. Health Information Technology

7. Data, Outcomes &

Quality

8. Public Awareness &

Support

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SAMHSA’S THEORY OF CHANGE

INNOVATIONProof of conceptServices ResearchPractice-based Evidence

TRANSLATIONImplementation ScienceDemonstration ProgramsCurriculum DevelopmentPolicy DevelopmentFinancing Models and Strategies

DISSEMINATIONTechnical AssistancePolicy AcademiesPractice RegistriesSocial MediaPublicationsGraduate Education

IMPLEMENTATIONCapacity BuildingInfrastructure DevelopmentPolicy ChangeWorkforce DevelopmentSystems Improvement

WIDESCALE ADOPTIONMedicaidSAMHSA Block GrantsMedicarePrivate InsuranceDOD/VA/DOL/DOJ/EDACF/CDC/HRSA/IHS

SURVEILLANCE

EVALUATION

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BUDGET: FY 2011 to FY 2014

Focusing on the Strategic Initiatives• FY 2011 budget reductions & RFAs & RFPs changing• FY 2012 budget proposal – focus on SIs, restructured to

support prevention and theory of change (IEI)• FY 2013 tough choices about programs and priorities

Revised Approach to Grant-Making • Revised BG application – moving toward 2014• Braided funding within SAMHSA & with partners• Engaging with States, Territories & Tribes – Flexibility

• Funding for States to plan or sustain proven efforts• Encouraging work with high-need communities

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BUDGET: FY 2011 to FY 2014 – 2

Implementing a Theory of Change• Taking proven things to scale (SPF, SOC, child trauma)• Researching/testing things where new knowledge is needed

(e.g., adult trauma, HIT, military families)

Efficient & Effective Use of Limited Dollars• Consolidating contracts & TA Centers• Consolidating public information & data collection activities and

functions

Regional Presence & Staff focus on States

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BUDGET: SAMHSAD

olla

rs in

Mill

ion

s ACA

PHS

BA

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RECOVERY: WORKING DEFINITION

In a context in which behavioral health is essential to health, recovery is:

A process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.

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RECOVERY PRINCIPLES

Person-centered

Occurs via many pathways

Holistic

Supported by peers Supported through relationships

Culturally based and influence

Supported by addressing trauma

Involves individual, family and community

strengths and responsibility

Based on respect

Emerges from hope

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RECOVERY CONSTRUCT

Individuals and Families

HOME ↑ Permanent

Housing

COMMUNITY ↑ Peer/Family/

Recovery NetworkSupports

PURPOSE ↑ Employment/

Education

HEALTH↑ Recovery

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RECOVERY ACTIVITIES – EXAMPLES

Recovery Support Strategic Initiative

Recovery Support Services in Health Reform & Block Grant

Recovery outcome measures

Recovery curricula for/with practitioners

Recovery TA Center (BRSS TACS)

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DISPARITIES

Disparities• Ethnic minorities > HHS Strategic Action Plan to Reduce Racial & Ethnic Health

Disparities• LGBTQ populations > LGBT Coordinating Committee• AI/AN Issues > Tribal Consultations• Women and girls

Office of Behavioral Health Equity - Key Drivers & Activities• HHS Office of Minority Health five core goal areas: awareness, leadership,

health system and life experience, cultural and linguistic competency, and data, research and evaluation

• AHRQ’s National Healthcare Disparities Report – identifies improving, maintaining and worsening health indicators, including depression, illicit drug use and suicide

• SAMHSA’s Eight Strategic Initiatives• Workforce (NNED)

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National Network to Eliminate Disparities in Behavioral Health (NNED)

www.nned.net

National Partners• 2008: 35• 2009: 134• 2010: 320• 2011: 386 500 AffiliatesTotal: 986

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DATA, QUALITY AND OUTCOMES

National Behavioral Health Quality Framework - building on the National Quality Strategy for Improving Health Care• 6 goals

1. Effective prevention, treatment and recovery practices2. Person- and family-centered3. Coordinated4. Best practices5. Safe6. Affordable, high quality

• 3 types of measures1. SAMHSA funded programs 2. Practitioner/system-based 3. Population-based

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NATIONAL BEHAVIORAL HEALTH QUALITY FRAMEWORK (cont’d)

June 15 Webcast/Listening Session – 500+ people• Draft document on web www.samhsa.gov

August 16 – SAMHSA National Advisory Council Use of SAMHSA tools to improve practices

• Models (SPF, coalitions, SBIRT, SOCs, suicide prevention)

• Emerging science (e.g., oral fluids testing)

• Technical Assistance (TA) capacity (trauma)

• Partnerships (meaningful use; Medicaid & Medicare quality measures)

• Services research as appropriate

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NATIONAL DIALOGUEWHERE DO WE START…

Behavioral health – prevention, treatment and recovery supports – is not viewed as a public health issue (cf. diabetes)

Result = focus on individual rather than focus on the community• Blame, assumption of morality in behavior,

discrimination, prejudice

Need = public commitment to children, families, prevention and treatment for healthy communities, recovery

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PERCEPTION CHALLENGES

>60% of people who experience MH problems & 90% of people who experience SA problems and need treatment do not perceive the need for care

Suicides are almost double the number of homicides– 2005-2009: 55%↑ in emergency department visits for drug

related suicide attempts by men aged 21 to 34

– 2005-2009: 49% ↑ in emergency department visits for drug related suicide attempts by women aged 50 +

Almost as many people need SA treatment as diabetes, but only 18.3 percent vs. 84 percent receive care

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PUBLIC EVENTS AND PROBLEMS

Violence in school board and city council meetings, in courtrooms & government buildings, on high school and college campuses, at shopping centers, in the workplace and places of worship – Grand Rapids, Tucson, Fort Hood, Virginia Tech, Red Lake, Columbine

Social problems that are visible and difficult – homelessness; drug-related gangs; child welfare issues due to drugs, addiction and mental illness

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COMMUNICATIONS & MESSAGES

Multiple messages; multiple philosophies = multiple and inconsistent responses and messages

Responses to problems rather than to people

Responses are concerned with fixing the problem (access to guns, security, background checks, more jail cells, more drug courts, increased police protection, shelters) rather than providing a public health solution for people and communities

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ASSESSING PUBLIC KNOWLEDGE AND ATTITUDES: WHAT AMERICANS BELIEVE

66 percent believe

treatment and support can help people with mental illness lead

normal lives

20 percent feel persons with mental illness are dangerous to others

Two-thirds believe

addiction can be

prevented

75 percent believe

recovery from

addiction is possible

20 percent say they would

think less of a friend/relative

if they discovered that

person is in recovery from an addiction

30 percent say they

would think less of a

person with a current addiction

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WHAT AMERICANS KNOW

Americans have general knowledge of basic first aid but not how to recognize MI or SA, or how or when to get help for self or others• Most know universal sign for choking; facial expressions of

physical pain; and basic terminology to recognize blood and other physical symptoms of illness and injury

• Most know basic First Aid and CPR for physical health crisis

• Most do not know signs of suicide, addiction or mental illness or what to do

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HOW DO WE CREATE . . .

A national dialogue on the role of BH in public life

With a common message and a public health approach that engages everyone • General public, elected officials, schools, families,

churches, health professionals• As well as persons affected by MI and addiction, and

their families

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HELP US CHANGE THE CONVERSATION!

IT’S A PUBLIC HEALTH ISSUE!!!

BEHAVIORAL HEALTH IS ESSENTIAL TO HEALTH

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